What the heck is “evidence based” proof? Is there another kind?
So many snake oil peddlers, so little time.
In “Evidence Based Proof Elderberry Syrup Is Better Than The Flu Shot”,1 Facebook saleswoman “Naturally Nicole” offers up more misinformation on the flu shot than can possibly be debunked in one sitting. In the interest of time, I’ll take on two of the three “scientific studies” she cites to support her flu cure, then come back for more in future articles.
Fasten your seat belts; make sure your tray tables are in a locked and upright position. It’s going to be a bumpy ride.
Claim #1
An extract of black elderberries has natural antiviral properties in vitro, and reduced flu symptoms in 3-4 days2
We have an epic failure right off the bat. In layman’s terms, in vitro means the study was performed in a glass test tube or petri dish, not a live human. So how did the elderberry extract reduce flu symptoms in humans?
Answer: it didn’t. This study wasn’t performed on humans, and Nicole & the abstract essentially tell a bald-faced lie. Here’s what happened:
Nicole starts you off with this abstract2 which describes a study performed courtesy of twelve volunteers who donated blood that was treated with elderberry extract in vitro. The humans didn’t have the flu. They didn’t have symptoms. The test was simply to determine if the elderberry triggered an immune response in the extracted cells. If you don’t read the paper behind the abstract, you never learn this vital fact.
It’s only when you read the full text of the study3 that you see the abstract’s reference to a reduction in symptoms isn’t for the study actually being done. This mysterious second paper and the reduction in symptoms in humans is never even mentioned anywhere but the abstract. I have to repeat myself, because it’s so important: the study cited by Nicole never tested a single flu patient, yet she and the abstract claim it reduced symptoms in humans in 3-4 days. Pretty amazing since it was an in vitro test only! (wink wink, nudge nudge.)
I’ve laid it out graphically for you below, and you can follow the results yourself via the hyperlinks in the article to see for yourself how you’re being misled:
Figures lie and liars figure. The study cited by Nicole didn’t actually test patients who had the flu, even though it seems to claim a reduction in symptoms. It slyly refers to ANOTHER study in the abstract. You have to actually read the paper to figure this out. Nicole makes a false claim because of this. (click/enlarge)
As for in vitro testing… that’s a necessary first step, but pushing it as a “cure” as Nicole does is dishonest. My wife and I have a great in vitro germ killer under the kitchen sink:
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Claim #2
A “complete cure” was achieved in 2-3 days in 90% of patients receiving elderberry syrup.4
At least we’ve switched to live humans (an in vivo study).
I think the most damning indictment of Nicole comes on the second page of the study that this vehement anti-vaxxer once again apparently didn’t take the time to read:
“Vaccinating those at high risk of influenza-related complications before the influenza season each year is the most effective and most commonly used ways [sic] of reducing the impact of influenza.” 4
That’s right. The very paper Nicole cites recommends the flu vaccine as the most effective way of combating influenza. (This is going to come back to haunt her, because the lead author of this study is also the lead author of the third paper she uses to prop up her product. You’ll never guess what he does for a living!)
So how was this study conducted? Did doctors do something objective, like, I don’t know… record the patients’ temperatures every day? Maybe some bloodwork?
No. Test subjects were asked to record in a diary how they felt. How well did they sleep? Were they coughing more or less?
I’m not making this up.4
(From the paper) That’s it? Couldn’t you go even to the trouble of taking their temperature?
Look, I get it: you can’t measure a body ache. But checking for a fever? And Nicole glosses over some facts. Twelve of the patients receiving the elderberry syrup (almost half!) needed a rescue medication during the study, because the syrup wasn’t working for them. It’s true that those in the control group (receiving a placebo) needed the rescue meds at a higher frequency, and recovered somewhat more slowly. But some recovered completely with no elderberry syrup at all, just as fast as those receiving the syrup. So what can you conclude? Well, the authors thought maybe they had something, maybe not, and said:
“These findings need to be confirmed in a larger study” 4
Nicole seems to have missed all of this.
Coming Up Next Time
In part 2 of this series, we’ll look at Nicole’s third study, a “switcheroo” piece that would have made Harry Houdini proud. Our Doctor of Syrup quotes from the abstract of a $51 per-view paper hidden behind a paywall–a paper that has some hidden surprises in it.
A paper Nicole very clearly didn’t read. It looks like this:
Coming up in part two of this series: why it’s always a good idea to read the papers you cite.
Image Credits
Naturally Nicole screen snapshots and product image captures are used in strict compliance with Title 17 U.S.C. Section 107 of United States copyright law (commonly known as “fair use law”). This material is distributed without profit with the intent to provide commentary, review, education, parody, and increase public health knowledge.
Bloom County/Opus image is used within parody constraints of Title 17 U.S.C. Section 107 of United States copyright law (commonly known as “fair use law”). This material is distributed without profit with the intent to provide commentary, review, education, parody, and increase public health knowledge.
Obfuscated image in closing sequence of “Inhibition of several strains of influenza virus in vitro and reduction of symptoms by an elderberry extract (Sambucus nigra L.) during an outbreak of influenza B Panama. J Altern Complement Med. 1995 Winter;1(4):361-9. Zakay-Rones Z1, Varsano N, Zlotnik M, Manor O, Regev L, Schlesinger M, Mumcuoglu M.” used to provide commentary, review, and increase public health knowledge as provided under Title 17 U.S.C. Section 107 of United States copyright law (commonly known as “fair use law”).
References
(1) Evidence Based Proof, Elderberry Syrup Is Better Than The Flu Shot
http://naturallynicolexo.com/evidence-based-proof-elderberry-syrup-is-better-than-the-flu-shot/
(2) The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. (ABSTRACT)
Eur Cytokine Netw. 2001 Apr-Jun;12(2):290-6.
Barak V1, Halperin T, Kalickman I.
http://www.ncbi.nlm.nih.gov/pubmed/11399518
(3) The effect of Sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. Inflammatory cytokines. (FULL TEXT)
Eur Cytokine Netw. 2001 Apr-Jun;12(2):290-6.
Barak V1, Halperin T, Kalickman I.
http://www.jle.com/fr/revues/ecn/e-docs/the_effect_of_sambucol_a_black_elderberry_based_natural_product_on_the_production_of_human_cytokines_i._inflammatory_cytokines_90261/article.phtml?tab=texte
(4) Randomized Study of the Efficacy and Safety of Oral Elderberry Extract in the Treatment of Influenza A and B Virus Infections
The Journal of International Medical Research
2004; 32: 132 – 140
Z ZAKAY-RONES , E THOM , T WOLLAN AND J WADSTEIN
http://imr.sagepub.com/content/32/2/132.long
Bad Science Debunked 